How to use or fill out D1216S Treatment Service Voucher for use by Specialists and Consultant Physicians only D1216S Treatm
- Click ‘Get Form’ to open it in the editor.
- Begin with the Patient Details section. Enter the patient’s file number, first name, initial, and surname. If the file number is unknown, include the date of birth and address.
- In the Item Number or Description of Service field, write down the relevant service details.
- Complete the ‘Condition Treated’ section only if applicable for White card holders or emergency services.
- Fill in the 'Treatment Location' section if services are not conducted in rooms. Specify the hospital if applicable.
- If pathology is requested, provide a brief description in the designated area.
- Ensure that the patient signs where indicated. If they cannot sign, complete that section accordingly.
- For emergency services, ensure to cross and sign the appropriate section.
- Submit the Departmental copy along with any relevant documents with your claim and ensure that the patient receives their copy.
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